Chromosomes and causation of human cancer and leukemia. IL. Therapeutic and prognostic value of chromosomal findings during acute phase in Ph1-positive chronic myeloid leukemia

Therapeutic and prognostic value of chromosomal AP classification at the blastic phase of Ph-positive chronic myeloid leukemia: comparison of data from Nagasaki University, Japan and Roswell Park Memorial Institute, U.S.A

To assess parameters of therapeutic response and survival after the onset of the blastic phase (BP) in 47 patients with Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML), a number of clinical hematologic, and cytogenetic data at the BP were evaluated. Among the eleven parameters examined, only the chromosomal findings correlated with the therapeutic response and survival after onset of the BP. The patients were divided into three groups on the basis of the chromosome findings in the bone marrow: one, with only a Ph (PP), another with two different clones, i.e., one clone with Ph only and another with additional karyotypic changes (AP), and a third group with only abnormal clones containing karyotypic abnormalities in addition to the Ph (AA). The number of patients with AA was 12, 18 with AP, and 17 with PP. The results were as follows: (1) The percentage of patients with a good therapeutic response was 25% (3/12) in AA, 22% (4/18) in AP, and 76% (13/17) in PP; (2) The median survival after the onset of the BP was 1.5 mo for AA, 2.4 mo for AP, and 7.3 mo for PP. Statistically, there was a significant difference between PP and the other two groups (p < 0.05). These data were reevaluated and compared to those of 64 patients with Ph-positive CML in Roswell Park Memorial Institute (RPMI) who had been reported earlier in 1983.

Monosomy 3 and isochromosome 8q in a uveal melanoma

Chromosome analysis of a locally invasive uveal melanoma revealed monosomy 3 and i(8q). Sublines with multiple copies of the i(8q) were also present. Loss of heterozygosity for genes on chromosome 3 and duplication of genes on 8q may play an important role in progression of uveal melanoma.

Cytogenetics and cell surface marker analysis in chronic myelocytic leukemia. II. Implications for patient management

Chronic myelocytic leukemia (CML) is a model system for the study of many aspects of malignant disease. One aspect that correlates with decreasing therapeutic response is tumor progression. This progression is often accompanied by clonal evolution. In those cases where aggressive therapy does not prevent this evolution, the clinical response to therapy usually proves to be poor and of short duration. Investigators are concentrating their efforts in three primary, but not mutually exclusive, areas with respect to the clinical management of CML. These include: an attempt to distinguish patients at risk for early transformation from those who will have a prolonged chronic phase; the cryopreservation of autologous bone marrow or buffy coat early in chronic phase for subsequent use in the accelerated phase and; endeavors to identify early markers for disease progression allowing intervention before an irreversible blast crisis occurs. This report deals with two types of potential prognostic markers of transformation: chromosomal and cell surface characteristics. The appearance of nonrandom abnormal chromosomal patterns has been correlated with myeloblastic transformation by many investigators. However, there has always been a subset of CML patients who do not undergo clonal evolution. Additionally, the type(s) of transformation in CML may vary depending on the cell lineages involved. Unlike myeloblastic transformants, many of our patients who do not exhibit clonal evolution as a concomitance of disease progression develop a lymphoblastic transformation. Cytofluorometric analysis can distinguish small populations of abnormal cells with lymphoblastic characteristics (HLA DR+). Initial data suggests that patients expressing the HLA DR+ in their "normal" peripheral blood cells are at risk of undergoing lymphoblastic transformation. The combined use of clinical, cytogenetic, and cytofluorometric data to predict an impending transformation and to discriminate between myeloblastic and lymphoblastic populations allows clinicians to manage their patients more effectively.

Significance of secondary cytogenetic changes in patients with Ph-positive chronic granulocytic leukemia in the acute phase

The karyotypic abnormalities in 29 patients in the acute phase of Ph-positive chronic granulocytic leukemia are described. Of 18 Giemsa banded samples, 11 showed one or more of the typical additional abnormalities found in the acute phase, namely +Ph, +8, or i(17q). Survival data from these patients was combined with three published series providing 135 patients and the effect of one, two, or three of these abnormalities tested. The prognosis was significantly worse in patients with two or more additional abnormalities, compared with those with one or none. Analysis of the subset of patients with only one additional abnormality [+Ph or +8 or i(17q)] suggested a worse prognosis in those with +8 than in those with +Ph or i(17q), although the differences were not significant. There also was a trend for patients in whom all metaphases showed abnormalities in addition to the Ph chromosome to have a worse prognosis than those in whom some or all metaphases contained the Ph only. However, this trend just failed to reach a 5% level of significance.

Chromosome changes and splenectomy in Ph1-positive CML. II. Prognostic aspects in the blastic phase

The effect of splenectomy during the blastic phase (BP) in Philadelphia (Ph1) positive chronic myeloid leukemia (CML) was correlated with the chromosome findings during that phase of the disease. Fifty-three patients were divided into six groups on the basis of the chromosome findings and splenectomy; i.e., nonsplenectomized and splenectomized patients with only a Ph1 clone (PP/S- and PP/S+); nonsplenectomized and splenectomized patients with a clone containing only a Ph1 and another clone with karyotypic changes in addition to the Ph1 (AP/S- and AP/S+), and nonsplenectomized and splenectomized patients with only abnormal clone(s) containing karyotypic abnormalities in addition to the Ph1 (AA/S- and AA/S+). The percentage of patients with a good therapeutic response in each group was higher in splenectomized than nonsplenectomized patients. The median survival after the onset of BP was 171 days (5.7 months) in PP/S-, 167 days (5.6 months) in PP/S+, 136 days (4.5 months) in AP/S-, 183 days (6.1 months) in AP/S+, 23 days (0.8 months) in AA/S-, and 155 (5.2 months) in AA/S+. Statistically, there was a significant difference only between AA/S- and the other groups. These findings may indicate that splenectomy during the blastic phase could contribute to an improved tolerance to chemotherapy in each group and prolong the survival after the onset of BP in AA patients.